MACRA Resources

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) changes the way psychiatrists and other physicians working with Medicare patients will be paid. The goal is to reimburse care based on quality and value rather than the number of services you provide.

Take Action Now to Avoid Medicare Penalties

The APA has developed a resource which includes detailed instructions on how psychiatrists can clarify their status under the Merit-based Incentive Payment System (MIPS) and what they can do now to earn higher payments and avoid future penalties.

Payment Reform is Coming

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) changes the way psychiatrists and other physicians working with Medicare patients will be paid. The goal is to reimburse care based on quality and value rather than the number of services you provide. Before the final rule was announced, the APA raised several concerns about MACRAs impact on psychiatry and their advocacy efforts paid off. To break down the new rule, the APA is working on a web-based toolkit and webinar series to help members understand the new MACRA rule. Learn more at psychiatry.org/MACRA.

MACRA Frequently Asked Questions

Here are some Frequently Asked Questions that NCPA has been receiving regarding MACRA and payment reform. The APA has great information on its website, so we have tried to answer these questions briefly and then provide the website link that will give you more information.

MACRA stands for “Medicare Access and CHIP Reauthorization Act”. MACRA is transforming how Medicare reimburses psychiatrists and other clinicians for providing services. The changes are designed to reward value and outcomes in one of two ways:

A: MIPS consolidates three previous Medicare incentive payment programs into one: PQRS, Meaningful Use and Value-Based Payment Modifier. CMS has approved hundreds of MIPS quality measures, but many will not be relevant to psychiatry. Fortunately, a “Mental/Behavioral Health” specialty measure is available for reporting. To view the quality measures, visit the CMS Website and filter by Specialty Measure Set

A. The easiest way to do MIPS reporting is to join APA’s national mental health registry, PsychPRO, which CMS has approved as a qualified clinical data registry. PsychPRO will provide tools and reports to help members maximize reporting through enhanced data collection and access to more relevant quality measures. APA members can sign up for free by going to the portal on the APA website. Once connected, PsychPRO does your MIPS reporting for you.

A: An Advanced Alternative Payment Model (APM) is a payment approach that gives added incentive payments to provide high quality cost efficient care. CMS must approval all Advanced APM, examples include Medicare Shared Savings Program Accountable Care Organizations (ACOs) and Next Generation ACO Models. A small number of psychiatrists are expected to earn APM incentives in the early stages of MACRA. There is currently no mental health/substance use models of care that have been approved as Advanced APMS. To learn more, download the APA's APM Fact Sheet.

A: 2018 continues many of the flexibilities of the “pick your pace” program but CMS no longer uses the phrase “pick your pace.” To avoid a rate penalty in 2020, clinicians must earn at least 15 points by correctly reporting a selection of measures to CMS, this can be achieved by submitting 6 quality measures that meet data completeness. To learn more, view the QPP Year 2 Fact Sheet.

A: The “performance period”—or the amount of time on which a physician must report—is 90 days for Advancing Care Information and Improvement Activities and 12 months for the Quality and Cost categories.

Merit-Based Incentive Payment System (MIPS)

MIPS combines portions of three quality programs: Meaningful Use (MU), the Physician Quality Reporting System (PQRS) and the Value-Based Payment Modifier (VBM). MIPS also adds a new category of Clinical Practice Improvement Activities.

Alternative Payment Models (APMs)

APMs include Accountable Care Organizations, Bundled Payments and Medical Homes. Participating in an advanced APM can exempt you from MIPS, and can lead to more favorable financial incentives, including a potential 5% lump sum bonus payment. Choosing an APM requires you to meet quality, financial risk and payer/revenue mix measurements.